CANCER IN TASMANIA INCIDENCE AND MORTALITY 1995
ACKNOWLEDGEMENTS The Department of Community and Health Services in Tasmania is acknowledged for financial support to the Registry. The work of collecting and collating cancer registry data would be much more difficult and time consuming without the continuing assistance of a number of people. These include staff members of: Medical Records departments of all Tasmanian hospitals WP Holman Clinics in Launceston and Hobart Private and public pathology laboratories The Registry of Births, Deaths and Marriages The Australian Bureau of Statistics. A special acknowledgment is due to doctors in private practice who respond to our written queries for additional information. During 1996 and 1997, the participation of our cancer registry in the National Breast Cancer Management Study has meant that many Tasmanian doctors have assisted us by completing quite lengthy questionnaires, and we are most appreciative of this. We are also encouraged by the response of Tasmanian men diagnosed with prostate cancer and their willingness to participate in the Tasmanian prostate cancer inheritance study. The clerical staff of the registry are commended for their commitment and efforts towards achieving 100% accuracy. This requires unremitting attention to detail. Dace Shugg Registrar DEPARTMENT of COMMUNITY and HEALTH SERVICES
CANCER IN TASMANIA INCIDENCE AND MORTALITY 1995 Menzies Centre For Population Health Research Editors: Dace Shugg, Terence Dwyer and David Couper Publication Date: December 1997 Tasmanian Cancer Registry Menzies Building 17 Liverpool Street, Hobart Postal Address: GPO Box 252-23 Hobart, Tasmania, Australia 7001 Telephone (03) 6226 7714 Facsimile (03) 6226 7704 www.healthsci.utas.edu.au/menzies/cancer Email: dace.shugg@utas.edu.au
THE TASMANIAN CANCER REGISTRY Members of the Advisory Committee Chairman Dr L Hardy-Wilson AM, Royal Australian College of Obstetricians and Gynaecologists Members Professor T Dwyer, Director, Menzies Centre for Population Health Research Professor K Muller, representing Royal College of Pathologists of Australasia Mr I Middleton, representing Royal Australasian College of Surgeons Professor R Lowenthal, representing Royal Australasian College of Physicians Dr J Ward, Director, WP Holman Clinic, Hobart Dr B Sundstrup, Director, WP Holman Clinic, Launceston Dr D Evans, representing Australian Medical Association Ms V Gardner, representing Department of Community and Health Services Mr L Ride, Executive Director, Cancer Council of Tasmania Mr S Commin, representing the Australian Bureau of Statistics Members of Staff Medical Director Professor T Dwyer Registrar Mrs D Shugg Medical Clerks Mrs K Jackman and Mrs V Webb Biostatistician Dr D Couper. Computing Consultant Mr D Wikeley Data Systems Consultant Dr C Shugg Clerical Assistance Mrs H Brettingham-Moore Library Mrs P Vallance Data Release Committee Dr R Kimber Dr M Baikie Dr S Gauden Dr R Kelsall 2
CONTENTS Page Acknowledgements Inside front cover Members of the Advisory Committee; Members of Staff; Data Release Committee 2 Demography of Tasmania 4 Key to ICD-9 Classifications for Individual Sites 5 Methods and Calculations 6 Summary of Consultations 7 Ten Most Frequently Diagnosed Cancers Incidence and Mortality 1995 8 Regional Distribution of Incidence Report 9 Cutaneous Malignant Melanoma (CMM) in Tasmania 1978 1996 10 Incidence and Mortality Tables 12 Summary of Incidence Table 32 Summary of Mortality Table 33 3
Population Demographics of Tasmania at 30 June 1995 Estimated Resident Population by Age Groups, Tasmania at 30 June 1995 Years Males Females Persons 0-4 17395 16702 34097 5-9 18025 17236 35261 10-14 18735 18055 36790 15-19 17475 16479 33954 20-24 17588 16662 34250 25-29 16419 16226 32645 30-34 17888 18636 36524 35-39 18383 18702 37085 40-44 17347 17307 34654 45-49 16432 16062 32494 50-54 12863 12481 25344 55-59 10849 10726 21575 60-64 9329 9635 18964 65-69 9181 9577 18758 70-74 7440 8950 16390 75-79 4775 6788 11563 80 & over 4417 8257 12674 All ages 234541 238481 473022 The ageing population of Tasmania Following the 1991 census, it was estimated that the median age had increased from 26.9 to 33.0 years in males, and from 27.8 to 34.3 years in females since the 1976 census. In 1993-1995, the life expectancy of Tasmanians was lower than the life expectancy of all Australians. Life Expectancy in Tasmania in 1993-1995 At birth At 60 yrs At 80 yrs Males 73.93 yrs 18.68 yrs 6.62 yrs Females 79.90 yrs 22.93 yrs 8.59 yrs Life Expectancy in Australia in 1993-1995 At birth At 60 yrs At 80 yrs Males 74.95 yrs 19.45 yrs 6.99 yrs Females 80.84 yrs 23.68 yrs 8.85 yrs 4
Key to ICD-9 Classifications for Individual Sites 5
METHODS AND CALCULATIONS The 1995 report contains numbers of new cases and deaths, and crude, cumulative, and age standardised incidence and mortality rates of Tasmanian residents diagnosed with cancer. Melanoma of the skin is presented in more detail. Incidence Cancer incidence is defined as the number of cases first notified in a given population during a specific period. The incidence data in this report relate to cancer cases first diagnosed between January 1995 and December 1995 in persons who were residents of Tasmania at the time of diagnosis. Mortality The mortality data in this report relate to deaths from cancer, of people who were first diagnosed as having cancer while they were residents of Tasmania. The Registrar of Births, Deaths and Marriages provides the Tasmanian cancer registry with copies of death certificates of all people who have died in Tasmania. Tasmanian cancer patients who die in other States in many instances are notified to the Tasmanian cancer registry by other State or Territory cancer registries. Details of patients diagnosed interstate who die in Tasmania are forwarded to the relevant State cancer registry. Non cancer deaths of Tasmanian cases are also recorded so that survival rates can be calculated. Deaths from non-melanocytic skin cancers (NMSC) are reported but incidence is not. In 1995, eight deaths were attributed to NMSC in Tasmania (6 men and 2 women). National Death Index (NDI) During 1997, cases notified to the Tasmanian Cancer Registry between 1978 and 1996 and still thought to be living, were checked against the NDI. This procedure alerted us to the fact that a considerable number of deaths of persons dying interstate had slipped through our net. All these deaths have now been added to our database. Calculation of rates Incidence and mortality rates were calculated per 100,000 population using the estimated Tasmanian population by age and sex for 1995 (Table 1) as supplied by the Australian Bureau of Statistics (ABS), Cat No. 3204.6. Age-sex specific rates These are calculated by dividing the numbers of cases in each 5 year age, sex and site specific stratum by the ABS population estimate for that stratum and then multiplying the result by 100,000. Age standardised rates These calculations are based on the World Standard Population Strata as described in Cancer Incidence in Five Continents, Volume IV, 1982, International Agency for Research in Cancer. Cumulative rates The cumulative rate (which is expressed as a percentage) is a good approximation of the risk which an individual would have of developing the disease in question if no other cause of death were to intervene. A cumulative rate of, say, 3.5% for melanoma in males would mean that one out of every 28 Tasmanian men would be expected to get melanoma by the age of 75 if he were not to die of another disease before that age. The corresponding rate from the 1995 data in women is one in 34. 6
Summary of Cancer Registry Consultations and Data Provision during 1996-97 During 1997, cancer data, analyses, graphics and intellectual input were provided to a number of organisations and individuals as listed below: Tasmanian Department of Community and Health Services: Latest available breast, cervix and skin cancer data for review of Health Goals and Targets Paediatric cancers in Tasmania 1991-1995 by type of cancer and Region within Tasmania Cutaneous Malignant Melanoma incidence and mortality trends in Tasmanian men and women An analysis of cancer Incidence and Mortality in the West Coast mining towns for the Epidemiological Profile of the West Coast for the West Coast Rural Planning Project The observed and expected rates of cancers occurring on the West Coast and a consultation in the form of a statistical interpretation of this data Cancer incidence and mortality report for the Wynyard area during 1990-1994 by type of cancer Provision of age standardisation programs written by Menzies Centre biostatisticians for calculation of incidence and mortality data for other diseases Men s Health Project Cancer incidence in Tasmanian men Data for Ministerials and other parliamentarians Mortality data for North West palliative care centre. BreastScreen TASMANIA Annual fast tracking of breast cancer cases into database to check for interval breast cancers. Tasmanian Cervical Cytology Register Regular liaison with cytology register to ensure completeness of data. International Association of Cancer Registries in Lyon France (IACR) Tasmanian Cancer Registry data for the years 1988-1992 for inclusion in Cancer Incidence in 5 Continents Volume VII. Australian Institute of Health and Welfare (AIHW) Data for Cancer in Australia 1991-1994 Listings for National Death Index (NDI) Data for AIHW monograph Breast Cancer in Australian women 1921-1994 Data for national breast cancer survival report in preparation. Australian Bureau of Statistics Coding Centre in Queensland WP Holman Clinics Provision of data to radiation oncologists and cause of death data for oncology database. Cancer Council of Tasmania Australian Paediatric Cancer Registry Australian Mesothelioma Registry HEALTH WATCH: The Australian petroleum industry health surveillance program Other state and territory cancer registries Ongoing exchange of data for completeness and avoidance of duplicate registration Patient information management services of public and private hospitals Consultation for difficult neoplasm classifications Launceston General Hospital Monash University National Breast Cancer Centre National breast cancer management study NSW Cancer Council Peter MacCallum Institute in Victoria Pharmacy Department, LGH Royal Australasian College of Surgeons Royal Brisbane Hospital Royal Hobart Hospital University of Sydney Doctors, researchers and students Media organisations 7
8 The Most Frequently Diagnosed Cancers Incidence and Mortality 1995
Regional Distribution of Incidence Report January 1995 December 1995 Regional Distribution of Incidence for all Sites with a minimum of 20 New Cases ICD-9 Site South North Mersey-Lyell Total Population 228268 133434 111320 473022* (48%) (28%) (24%) (100%) 185. Prostate 168 (41%) 142 (34%) 104 (25%) 414 174-5. Breast 118 (45%) 93 (35%) 51 (19%) 262 162. Lung 112 (53%) 58 (28%) 40 (19%) 210 153. Colon 97 (52%) 53 (28%) 38 (20%) 188 172. Melanoma of Skin 99 (54%) 48 (26%) 35 (19%) 182 154. Rectum 55 (48%) 39 (34%) 21 (18%) 115 199. Unspecified Site 41 (41%) 37 (37%) 21 (21%) 99 188. Bladder 50 (51%) 30 (31%) 18 (18%) 98 200-2. All Lymphomas 32 (44%) 24 (33%) 17 (23%) 73 151. Stomach 27 (47%) 20 (35%) 10 (18%) 57 204-8. All Leukaemias 42 (74%) 9 (16%) 6 (11%) 57 157. Pancreas 31 (64%) 9 (18%) 9 (18%) 49 189. Kidney 30 (59%) 11 (22%) 10 (20%) 51 140. Lip 19 (45%) 13 (31%) 10 (24%) 42 150. Oesophagus 20 (48%) 14 (33%) 8 (19%) 42 203. Multiple Myeloma 21 (58%) 9 (25%) 6 (17%) 36 183. Ovary 18 (51%) 8 (23%) 9 (26%) 35 182. Corpus Uteri 16 (57%) 4 (14%) 8 (29%) 28 191. Brain 10 (36%) 7 (25%) 11 (39%) 28 180. Cervix Uteri 12 (44%) 9 (33%) 6 (22%) 27 193. Thyroid 15 (71%) 3 (14%) 3 (14%) 21 * Estimated Resident Population at June 1995 (ABS) Statistical Division Boundary 9
CUTANEOUS MALIGNANT MELANOMA (CMM) IN TASMANIA 1978-1996 Incidence and mortality trends are reviewed for cases of CMM notified to the Tasmanian Cancer Registry between 1978 and 1996. During this time a total of 2045 new cases were registered and 288 deaths from CMM were recorded. Data for the 6 time periods were as follows: Incidence Mortality Males Females Males Females Years ASR ASR ASR ASR 1978-81 11.0 13.6 2.4 2.2 1982-84 12.7 15.7 4.0 3.2 1985-87 13.9 21.8 5.1 2.7 1988-90 22.8 25.2 3.4 2.7 1991-93 24.4 21.4 3.2 2.1 1994-96 30.7 28.0 2.8 1.3 Incidence The age standardised rates (ASR) per 100,000 are the average annual rates. Data is presented in three year time periods with the exception of 1978-1981 for which four years of data are averaged. It is apparent from this analysis, that female incidence rates were higher than male incidence rates until 1989 but declined between 1990 and 1993. The incidence rate in males has risen more steeply than the rate in females in the period up to 1993 and male rates are now higher than female. Figure 1: Melanoma incidence and mortality rates Males and Females 1978-1996 35 Age standardised rate 30 25 20 15 10 5 female incidence male incidence female mortality male mortality 0 1978-81 1982-84 1985-87 1988-90 1991-93 1994-96 Year of diagnosis or death from CMM Mortality Melanoma mortality rates have decreased since the 1985-1987 time period for both men and women but remain higher for men than women. 10
Cutaneous Malignant Melanoma (CMM) in Tasmania-1978-1996 Figure 2: Age specific INCIDENCE rates of CMM for males and females, 1978-1996 120 Age specific rate 100 80 60 40 20 females males 0 10-14yrs 20-24yrs 30-34yrs 40-44yrs 50-54yrs 60-64yrs 70-74yrs 80-84yrs Age at which CMM was diagnosed Age specific incidence rates Age specific incidence rates calculated in 5 year age groups indicate that incidence of CMM increases with age. In men the increase continues until 80 years of age after which it decreases in the 85+ age group. In women rates are higher than those in men until the age of 50-59 at which point the lines cross and female rates remain below those of male rates for all the older age groups. Figure 3: Age specific MORTALITY rates of CMM for males and females, 1978-1996 40 35 Age specific rate 30 25 20 15 10 5 0 10-14yrs 20-24yrs 30-34yrs 40-44yrs 50-54yrs 60-64yrs 70-74yrs 80-84yrs Age at death from CMM females males Age specific mortality rates Age specific mortality rates for males are generally higher than for females. Mortality rates increase steadily with age. 11
INCIDENCE Summary Table Tasmanian Cancer Incidence 1995 32
MORTALITY Summary Table Tasmanian Cancer Mortality 1995 33